INDIA: Sex-change Surgery Latest On India’s Budget Medical Tourism Catalogue

After decades of battling depression, former soldier Betty Ann Archer finally flew to New Delhi to complete her gender transition, one of a growing number of foreigners heading to India for budget sex-change operations.

Born Dale Archer, the 64-year-old American said she felt trapped in the wrong body right from the start, recalling secretly trying on her mother’s dresses as a boy much to the horror of her conservative military father.

“I attempted to kill myself twice, I didn’t like myself. I didn’t like my body at all. I couldn’t be myself,” said Archer, who is from Arizona.
“I became very ill in 2011 and almost died,” she said, wearing a bright blue sari and ornate Indian jewellery that she bought after her gender reassignment surgery in Delhi.

“While I was recovering I came to the conclusion that I had to transition or die.”

A small but steadily increasing number of transgenders are travelling to socially conservative India for such procedures, which are cheaper than those in their homelands and with no waiting lists, according to industry experts.

Some are even choosing India, which has traditionally shunned its own transgender community, over leading sex-change destination Thailand which is regarded as more accepting on this issue.

In November, Archer found herself at the Olmec Centre nestled in a northern Delhi neighbourhood, which she picked over clinics in Thailand which she felt were “just a bit too expensive”.

“This is affordable. This is an option that some transgender people can look at and not have to kill themselves because they can’t afford it,” said Archer, who paid about $6,000, a fifth of the price back home, and said India’s conservative views on transgenders had not been an issue when deciding to come.

Shopping trips
For up to $22,000, Olmec provides the treatment, but also accommodation, airport shuttles and post-operative care that includes shopping trips and visits to the Taj Mahal and other tourist favourites.

Olmec founder and plastic surgeon Narendra Kaushik said he operates on up to 200 mostly local patients a year.

But Kaushik said he was also seeing increasing numbers of foreigners: Westerners from countries such as the UK, US, and Australia, seeking lower costs and those from developing countries wanting better quality care than they receive at home.

The number of foreign nationals having such surgeries has jumped from between five and ten to as many as 20 a year, Kaushik said, predicting the figure would continue to rise.

He explained: “The number of surgeries are increasing day by day.

“This community is very well connected all over the world. If they are satisfied with their procedures in India, they spread the word.”

The government is actively promoting India’s booming medical tourism industry, including by recently overhauling a special M-visa, now issued faster and valid for one year.

The $3 billion industry is expected to more than double in size by 2020, a report published last year from the Confederation of Indian Industry says.

More than 250,000 patients seeking everything from hip replacements to facelifts are travelling to India annually, according to US-based consulting firm Patients Beyond Borders.

The number pales in comparison to Thailand which draws up to two million patients a year, but the firm’s CEO Josef Woodman was confident India would become a future leader in the niche area of gender affirmation surgeries.

“I think in another three to five years. It takes time,” Woodman said of the surgeries, performed by less than a dozen Indian surgeons mostly in Delhi and Mumbai.

Woodman said, however, some foreigners might question India as a destination given that its own transgender community is vulnerable to discrimination.

Known as “hijras”, India several million transgenders are often outcasts. Shunned from society some end up destitute forced to beg or into prostitution.

‘Wanted the best’
Retired British violinist Rosy Mica Kellett decided to travel to India for male-to-female surgery based on glowing recommendations for her surgeon. It was also 14,000 pounds ($20,000) -- less than half the cost in the UK.

“It’s significantly cheaper here than it is back home and in most countries, even including Thailand,” said the married 50-year-old during a recent follow-up appointment with Kaushik.

“Some of the feedback I received for this kind of procedure in Thailand didn’t seem to be as super advanced as my surgeon performs,” said Kellett, formerly known as Michael, dressed in a flowing maxi dress.

“I wanted the very best and I got the very best.”

Indian surgeons are also developing their own techniques for transgender operations, including for female-to-male surgeries, which are complex and less widely available, according to industry experts.

But Shobha Mishra Ghosh, senior director of Indian industry body Ficci, said policymakers need to work harder if India was to become a top destination.

She suggested further streamlining of visa and immigration processes, as well as help desks at airports and more language interpreters.

“If we can bring the entire ecosystem in place, a lot of traffic that is going to other countries will get diverted to us,” Ghosh said.
“In that sense, I think we have a winner out there.”

Medical Tourism Booms In Asia

THE lines snaking into Bangladesh's overwhelmed hospitals are often so long, says Nusrat Hussein Kiwan, that they extend into the street outside, too many patients seeking too few quality doctors.

So, through a Google search, the wife of a Bangladeshi construction executive chose a Malaysian hospital for her heart bypass surgery.

"It's peaceful here, and my doctors are good," Kiwan, 65, said during a post-op check-up at a Kuala Lumpur private hospital, looking full of life in an orange headscarf and sparkling gold bracelets.

"I didn't expect to be as good as before. But I'm better."

Kiwan spent RM20,000 on the procedure earlier this year, joining a booming global medical tourism market that is seeing particularly rapid growth in Southeast Asia.

US-based industry resource Patients Beyond Borders estimates the world market is expanding by 25 percent per year -- it reached US$55 billion with 11 million medical tourists in 2013.

International medical tourism began to gain ground in the 1980s as Latin American countries such as Costa Rica and Brazil offered relatively cheap dental, cosmetic and other procedures to US and European patients driven south by high costs.

But the onetime niche market has developed into a multi-billion-dollar industry as developing-world health systems improve, global aviation links spread, and the Internet broadens patients' horizons.

Procedures vary widely from fertility treatments in Barbados, to cosmetic surgery in Brazil, heart and eye operations in Malaysia, and gender-reassignment in Thailand.

The sector benefits from a "perfect storm of an ageing global population, rising affluence and greater choice in quality hospitals," said Josef Woodman, CEO of Patients Beyond Borders.

"This is particularly true in Asia, where disparities in quality of care are driving millions of patients to countries such as Thailand, Malaysia, South Korea, Taiwan -- and even the US and UK -- in search of medical treatment not yet available in their homelands."

"The near-term growth potential is significant," he said.

Increasingly, major Asian players like India, Malaysia, Singapore and Thailand are aggressively promoting treatments at up to 80% savings compared to developed nations, with some companies arranging package trips that combine a nose job with a little beach time.

Southeast Asia, in particular, is considered a medical-tourism "sweet spot," with decades of solid economic growth creating high-quality medical systems that remain competitively priced.

Patients come from both rich and poor nations, the former driven by high costs at home, and the latter seeking better-quality care.

Malaysia's market has nearly doubled since 2010, reaching 770,000 patients and RM200 million in revenue last year, according to government figures.

"We are behind Thailand for sure, but we are giving Singapore a good fight," said T. Mahadevan, head of the Association of Private Hospitals of Malaysia.

Thailand says it attracted 2.53 million medical tourists in 2012. Though its figures include spa tourists, that's a one-third increase in just two years, a period in which revenues nearly doubled to around US$4.2 billion.

In Singapore, medical tourists spent US$630 million last year, a figure likely inflated by the modern city-state's relatively higher costs. Patients Beyond Borders estimates Singapore draws more than a half-million treatment-seekers annually, mostly from neighbouring Indonesia, where health systems lag.

Malaysia set up a special body in 2009 to streamline and organise industry players.

Patients Without Borders calls Malaysia "medical travel's best-kept secret", noting the widely spoken fluent English and far cheaper medical costs compared to Japan, the United States, Europe and other key clientele sources.

"I would come back here again. I would definitely recommend it," Alexandria Garvie, 61, said from her hospital bed in Kuala Lumpur after a tummy tuck.

The RM5,000 procedure -- around one-quarter of what she would have paid at home in Australia -- was performed at the Beverly Wilshire Medical Centre.

The company also recently opened a new branch near the border with Singapore to entice patients from the more affluent city-state.

Most medical tourists to Malaysia, however, are well-heeled visitors from less-developed Indonesia, followed by Indians, Japanese and Chinese. Future growth is expected from the wealthy Middle East.

Ancillary businesses have sprouted.

Beautiful Holidays, based on the northern Malaysian island of Penang, connects overseas clients with local cosmetic surgeons, arranges their accommodations, and shepherds them to pre- and post-op check-ups.

But it also arranges drinks, dining and sightseeing in Penang, know for its historical sites, beaches and cultural melange.

"The idea is to have people come here for holidays -- sun and silicone, that kind of thing," said Tony Leong, the company's programme director.

Ashley Higgins, a 30-year-old American, has used the company twice, first for a breast augmentation, then a nose job.

She was initially wary of going under the knife on the other side of the globe, but price concerns won out.

"The hard part is trusting people when you are 1,000 miles from home. I felt comfortable coming here," she said.